Provider Demographics
NPI:1053781864
Name:SMITH, KRISTOPHER
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97121-9808
Mailing Address - Country:US
Mailing Address - Phone:716-598-7855
Mailing Address - Fax:
Practice Address - Street 1:65 NORTH HIGHWAY 101, SUITE 204
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health